Provider Demographics
NPI:1720560543
Name:NABIL R. IBRAHIM B.D.S., D.D.S., PLLC
Entity Type:Organization
Organization Name:NABIL R. IBRAHIM B.D.S., D.D.S., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, DDS
Authorized Official - Phone:781-729-1159
Mailing Address - Street 1:10 CONVERSE PL STE 102
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2713
Mailing Address - Country:US
Mailing Address - Phone:781-729-1159
Mailing Address - Fax:
Practice Address - Street 1:10 CONVERSE PL STE 102
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2713
Practice Address - Country:US
Practice Address - Phone:781-729-1159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19668261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental